Part 2 : Reflection (1000 WORDS)
1000 words essay
Reflection on Prevention of Medication Errors
Strategies for Implementation of Recommendations
Evidenced-based practice is important for both clinical and nursing practice. Recommendations and a strategic plan require a good choice of an appropriate implementation framework. Recommendations for a given intervention should be linked to a specific implementation strategy. The essay proceeds to give implementation strategies as well as potential barriers and enablers to implementation in a primary care setting.
The first recommendation focuses on the employment of sufficient number of healthcare personnel to meet the proportion of expected patient numbers in a day and their conditions. The rationale was to reduce the risk of work-associated fatigue and stress so as to reduce the risk of medication errors (MEs) (Gorgich et al., 2016). Nurse-managers should work with policy-makers and other key decision-makers to advocate for employment of sufficient human resource. Enabling factors include availability of funds to pay additional staff and well-qualified and trained staff. Limited financial resources and the need to outsource human resource may limit implementation of this recommendation.
The second recommendation advocates for improvement of nurse pharmacological knowledge as one of the effective strategy for reduction of MEs (Cheragi et al., 2013). Implementation strategies include improvement of pharmacological-based knowledge and skills during training of medical students (including nurses). Enablers include establishment of proper cooperation between training institutions and hospitals. Besides, pharmacological content can be increased or improved during student internship or attachment program. Existing training institutions that have links with some leading hospitals is a key enabler. However, low pharmacological content in coursework may hinder implementation of this recommendation.
The third recommendation stresses on encouragement of nurses and physicians to report errors. Error reporting allows for identification of common errors and informs policy or strategy development to prevent similar errors in the future (Eden & Ismail, 2016). Implementation strategy includes involving and engaging all medical staff in training and educational training that focusing on error reporting. Potential enablers of this recommendation include introduction of a zero-blame policy and not punishing staff for medication errors. But instead take appropriate measures to prevent similar occurrences in the future. Conversely, blaming and punishing staff for medication errors are some of the barriers impeding implementation of the above recommendation. Eden and Ismail (2016) noted that voluntary error reporting is determined by staff awareness thus can be resolved through training and education.
The fourth recommendation is to minimize level of interruption when administering medications. Interruptions increases the risk of ME occurrence (Raba & Westbrook, 2014). The implementation strategy would be approached through policy change and employment of more staff to address almost all medical associated issues at a particular point in time. Enabling conditions include establishment of staff management systems that shows engaged and free staff in real time and availability of enough resources to allow for additional staff. Identified implementation barriers may include insufficient funding and/or inadequate revenue collections, lack of staff management systems, and having staff working on different patient issues, thus, increasing the risk of being called-in to address emergency situations while administering medications.
This reflection is based on what I learnt when I was creating an evidence-based practice poster for prevention of MEs. Breimaier and colleagues (2013) noted that translation of evidence-based practice into nursing practice remains a challenge. In addition, there is great discrepancy between research findings and actual clinical practice (Breimaier et al., 2013). Similarly, I observed that evidence-based publications provide efficient strategies and solutions for day to day issues encountered in medical/ nursing practice but several barriers and challenges should be tackled first to allow for successful implementation of evidence–based practices into routine nursing practice.
There should be an established linked between distilled knowledge through research and publications with the nursing practice (Breimaier et al., 2013). Through my limited research I noted that there are several publications recommending different strategies for prevention of MEs but little have been done to translate the findings into practice. If recommendations from evidence-based publications could have all been put into practice then MEs could have been reduced significantly. I am disturbed by the fact that hundred o to thousands of evidence-based research articles may be published every year but little trickle down to clinical/ nursing practice.
Enhancement of medical or nursing student training approach and content could be one of the important strategies for solving various issues facing medical profession as a whole such as incidences of MEs. Evidence-based practice application in both undergraduate and graduate nursing education has a long history. It is critical element in nursing education (Mackey & Bassendowski, 2017). Nurse educational courses and teaching strategies should also mirror most recent evidence-based knowledge and practices (Griffith, 2012). Besides, Fiset, Graham and Davies (2017) recommended that evidence-based knowledge and skills should be integrated into nursing student education program. Evidence-based content knowledge should also be employed as means of improving competency of current working staff by introducing frequent refresher course and re-training of staff based on current and most up to date research findings to improve care safety, increase patient satisfaction and improve quality of care.
Fiset and colleagues (2017) stressed on the importance of using evidence-based publication for education medical/nursing students in both clinical and classroom settings. It is also important to note that an evidence-based knowledge or practice published a decade ago may have been declared obsolete or infective by the most current research findings. Thus teaching and training should almost be directed by the most current, relevant, valid and scientific-based evidence-based publications. However, McCrae (2012) cautions on careful analysis of evidence-based publications before translating their findings into practice. Author’s errors and doctored findings may lead to drastic outcomes in a clinical setting.
I found systematic reviews of evidence as a key strategy for directing policy-makers and decision-makers on the efficacy, quality, or safety of different strategies for resolving specific issues such as medication errors based on comparisons. Besides, I established the fact that primary studies may be limited in terms of scope and comparisons compared with systematic reviews of randomised controlled trails or other reviews. Curtis et al. (2016) added that evidence and knowledge generated by robust scholarly approaches may help to shape decision-making process, adoption of change, and improving delivery of care. It is important to note that before research evidence and knowledge are translated into real practice; as aspects such as transparency, safety, efficient, and effective should be determine with respect to clinical or nursing practice.
Breimaier, H.E., Halfens, R..G., Wilborn, D., Meesterberends, E., Nielsen, G.H., & Lohrmann, C. (2013). Implementation Interventions Used in Nursing Homes and Hospitals: A Descriptive, Comparative Study between Austria, Germany, and The Netherlands. IRSN Nurs., 2013(2013), 706054.Doi: 10.1155/2013/706054
Cheragi, M.A., Manoocheri, H., Mohammadnejad, E., & Ehsani, S.R. (2013). Types and causes of medication errors from nurse’s viewpoint. Iran J Nurs Midwifery, 18(3); 228-231.
Curtis, K., Fry, M., Shaban, R.Z., & Connsidine, J. (2016). Translating research findings to clinical nursing practice. JCN, 26(5-6), 862-872. DOI: 10.1111/jocn.13586
Elden, N.M.K., & Ismail, A. (2016). The importance of Medication Errors Reporting in Improving the Quality of Clinical Care Services. Glob J Health Sci., 8(8); 243-251. DOI:10.5539/gjhs.v8n8p243.
Fiset, V.J., Graham, I.D., & Davies, B.L. (2017). Evidence-Based Practice in Clinical Nursing Education: A Scoping Review. Journal of Nursing Education, 56(9), 534-541. DOI: 10.3928/01484834-20170817-04.
Gorgich, E.A.C., Barfroshan, S., Ghoreishi, G., & Yaghoobi, M. (2016). Investigating the Causes of Medication Errors and Strategies to Prevention of Them from Nurses and Nursing Student Viewpoint. Glob J Health Sci., 8(8); 220-227. DOI: 10.5539/gjhs.v8n8p220
Griffith, L.M. (2012). Course portfolios as evidence-based reflection. General Anthropology, 19(1), 1-7. DOI: 10.1111/j.1939-3466.2012.00001.x
Mackey, A., & Bassendowski, S. (2017). The history of evidence-based practice in nursing education and practice. Journal of Professional Nursing, 33(1), 51-55. DOI: http://dx.doi.org/10.1016/j.profnurs.2016.05.009
McCrae, N. (2012). Evidence-based practice: for better or worse. International Journal of Nursing Studies, 49(9), 1051-1053. DOI: http://dx.doi.org/10.1016/j.ijnurstu.2012.08.010
Raba, M.Z., & Westbrook, J.I. (2014). Are interventions to reduce interruptions and errors during medication administration effective?: a systematic review. BMJ Qual Saf., 23(5), 414-21. DOI:10.1136/bmjqs-2013-002118.